臺灣博碩士論文加值系統

關節炎是老年族群最常見的問題，其中又以持續的慢性疼痛時常困擾著老年病患。目前國內對於慢性疼痛及其與身、心及社會等層面的研究有限。因此，本研究目的為探討長期照護機構老年住民關節炎慢性疼痛之狀況，探討長期照護機構罹患關節炎之老年住民社會人口學特質、憂鬱狀態、日常活動功能、社會支持、和慢性疼痛之相關性，進而探討長期照護機構老年關節炎住民慢性疼痛預測之重要因素。本研究採橫斷式、描述相關性研究設計，以方便取樣，用結構式問卷收集114位高雄市及屏東市五所已立案的長期照護機構65歲（含）以上、清醒、認知功能正常的個案。研究結果顯示安養（護）機構老人關節炎慢性疼痛病患其最近三個月之平均疼痛達中度（X＝4.51±1.75）。最近三個月之平均疼痛，與疼痛部位總數、過去疼痛事件之疼痛分數、自覺關節炎嚴重度、憂鬱狀況呈正相關（p＜ .01）；與年齡、罹患慢性病數目、日常活動功能、社會支持呈負相關（p＜ .01）。過去最痛事件之最痛程度、自覺關節炎嚴重度、慢性病總數、日常活動功能及憂鬱狀況五個變項對慢性疼痛有預測力（p＜ .01），其總解釋變異量達40.4%。關節炎慢性疼痛的問題確實存在於長期照護機構中，而其影響因素呈現多元，依研究結果建議，健康專業人員應深入評估關節炎老人之慢性疼痛及身體、心理與社會等層面。

Abstract
Arthritis in elderly people has become a common problem of health. Chronic pain resulting from arthritis is a threat to the elderly population. However, the current literature on the treatment modalities for arthritis focus on the aspect of inquisition of pain prevalence and its treatment tactics, rather than the connection of body, mind and social dimensions. Only limited research focuses on the area of body, mind and social connection. The purpose of this study was three folds: (1) to investigate the chronic pain of elderly residents in long-term care facilities with arthritis, (2) to explore the relationships among socio-demographic variables, depression status, disability condition, social support and chronic pain, and (3) to identify the predictive factors of chronic pain. A convenient sample of 114 elderly residents, aged 65 and older, were included from five long-term care facilities in Kaohsiung and Pington, Taiwan. A cross-section method is applied to delineate correlation design by way of structural formula questionnaire for data collection.
The findings showed that the average degree of pain resulting from chronic arthritis during the recent three months was medium (4.51 ± sd1.75). There were positive relationships among the average degree of pain, the pain score to the past painful events, self-perceived degree of severity of arthritis and depression status in the recent three months. Negative correlations were found among age, self-perceived degree of severity of arthritis, the number of chronic illnesses experienced, function of daily activity and social support. Five predictors of chronic pain were found. They are: the degree of pain of the most painful event in the past, self-perceived degree of severity of arthritis, the number of chronic illnesses experienced, function of daily activity and depression status. These five predictors accounted for 40.4% of the variance for the average degree of chronic pain.
Chronic pain resulting from arthritis is realistically present in the long-term care facilities. The factors that impact this problem are multi-factorial. The results of this study suggest that it is imperative for the health care providers to provide in-depth assessment to chronic pain, and the connection of body, mind and social dimensions for the elderly residents in the long-term care facilities who are suffering from arthritis.

目錄
誌謝………………………………………………………………i
摘要………………………………………………………………ii
英文摘要…………………………………………………………iii
目錄………………………………………………………………v
圖目錄……………………………………………………………viii
表目錄……………………………………………………………ix
第一章 緒論…………………………………………………… 1
第一節 研究動機及重要性…………………………………1
第二節 研究目的及研究問題……………………………....7
第三節 名詞界定…………………………………………....9
第二章 文獻查證………………………………………………..12
第一節 關節炎………………………………………………12
第二節 慢性疼痛……………………………………………15
第三節 關節炎慢性疼痛之相關因素……………………….18
第四節 慢性疼痛之測量工具……………………………….27
第三章 研究方法 ……………………………………………….32
第一節 研究設計 …………………………………………. 32
第二節 研究地點……………………………………………33
第三節 研究對象及選樣 ………………………………….34
第四節 研究工具及其信效度 ……………………………35
第五節 研究步驟……………………………………………42
第六節 研究倫理……………………………………………43
第七節 資料處理與分析……………………………………44
第四章 研究結果…………………………………………………46
第一節機構關節炎老人慢性疼痛之人口學特性………… 46
第二節機構關節炎老人慢性疼痛之狀況…………………52
第三節常態檢定……………………………………………58
第四節機構關節炎老人慢性疼痛與人口學特質之關係. …61
第五節機構關節炎老人慢性疼痛與日常活動功能之相關
性…………………………………………………… 65
第六節機構關節炎老人慢性疼痛與憂鬱狀況之相關性…67
第七節機構關節炎老人慢性疼痛與社會支持之相關性…69
第八節機構關節炎老人慢性疼痛之預測因子 …………70
第五章結論與討論………………………………………………79
第一節研究結論……………………………………………79
第二節研究結果與其他相關研究比較分析………………81
第三節研究之限制…………………………………………92
第四節應用與建議…………………………………………95
參考資料…………………………………………………………98
中文部分…………………………………………………………98
英文部分………………………………………………………. 105
附錄一 研究參與同意書………………………………………121
附錄二 簡易心智狀態問卷調查表……………………………122
附錄三 正式施測問卷…………………………………………123
基本人口學資料表…………………………………….123
日常活動功能量表…………………………………….125
簡易老人憂鬱量表…………………………………….127
社會支持調查量表…………………………………….128
簡易疼痛量表………………………………………… 129
附件四 研究工具使用同意書…………………………………132








圖目錄
圖一機構關節炎老人之慢性疼痛及其相關因素探討之研究架構 …8
圖二自變項對慢性疼痛之影響………………………………………78





















表目錄
表3-1 資料分析步驟及方法………………………………… 45
表4-1人口學分布情形……………………………………… 49
表4-2機構老年關節炎病患慢性疼痛狀況………………… 55
表4-3各變項之常態性檢定結果…………………………… 60
表4-4人口學變項、日常活動功能、憂鬱狀況及社會支持與
慢性疼痛之相關分析………………………………… 63
表4-5人口學變項與慢性疼痛之t檢定…………………… 64
表4-6婚姻狀況與慢性疼痛之變異數分析………………… 64
表4-7研究對象之依賴程度………………………………… 64
表4-8研究對象身體活動功能狀態………………………… 65
表4-9簡易老人憂鬱量表問卷評量結果…………………… 67
表4-10依序排列之「社會支持調查表」問卷評量結果…… 68
表4-11共線性診斷…………………………………………… 70
表4-12相關變項對慢性疼痛之反向複迴歸分析………… 73
表4-13四則慢性疼痛預測方程式之殘差值分析檢定……… 75
表4-14慢性疼痛複迴歸分析………………………………… 77

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